Menstrual abnormalities are:
- Amenorrhoea
- Dysmenorrhoea
- Polymenorrhoea/ Epimenorrhoea
- Oligomenorrhoea
- Menorrhagia/ Hypermenorrhoea
- Polymenorrhagia
- Metorrhagia/ Metrostaxis
- Menometrorrhagia
- Hypomenorrhoea
Amenorrhoea
Definition: Amenorrhoea means absense of menstruation.
It is a symptom and not a disease.
There are at least five basic factors involved in the onset and continuation of normal menstruation. These are:
- Normal female chromosomal pattern (46XX
- Coordinated hypothalamo-pituitary-ovarian axis
- Anatomical presence and patency of the outflow duct.
- Responsive endometrium
- Active support of thyroid and adrenal glands.
Clinical Types of Amenorrhoea:
A. Physiological:
- Primary amenorrhoea
- Before puberty: The pituitary gonadotrophins are no adequate enough to stimulate the ovarian follicles for effective steroidogenesis-==>Oestrogen levels are not sufficient enough to cause bleeding from the endometrium.
- Secondary amenorrhoea
- During pregnancy: Large amount of oestrogens and chorionic gonadotrophins secreted from the trophoblasts suppress the pituitary gonadotrophins.==>No maturation of the ovarian follicles.
- During lactation: High level of prolactin inhibits ovarian response to FSH. So no follicular growth occurs.==>Hypo-oestrogenic state==>no menstruation.
- Following menopause: No more responsive follicles are available in the ovaries for the gonadotrophins to act. As a result, there is cessation of oestrogen production from the ovaries with elevation of pituitary gonadotrophins.
B. Pathological:
- Concealed (cryptomenorrhoea)
- Congenital
- Acquired
- Real (True)
- Primary
- Secondary
Primary Amenorrhoea
Definition: Primary amenorrhoea is the absence of menstruation by 16 years of age in the presence of normal secondary sexual characteristics, or by 14 years of age if secondary sexual characteristics have not been developed.Causes of Primary amenorrhoea:
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